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Provider Notice issued 02/03/14

Cost Sharing for Behavioral Health Encounters

To:​ Enrolled Encounter Rate Clinics, Federally Qualified Health Centers (FQHC), and Rural Health Clinics (RHC)​
​Date: ​February 3, 2014
​Re: ​ Cost Sharing for Behavioral Health Encounters

The department has made changes regarding cost sharing for behavioral health encounters. For dates of service on or after February 1, 2014, the department will be implementing a co-payment of $3.90 for behavioral health encounters rendered to most adults.
The following individuals are exempt from copayments:
  • Residents of nursing homes, specialized mental health rehabilitation facilities, intermediate care facilities for the intellectually disabled.
  • Residents of State-certified, -licensed, or -contracted residential care program where residents, as a condition of receiving care in that program, are required to pay all of their income, except an authorized protected amount for personal use, for the cost of their residential care program (e.g., supportive living facilities, community integrated living arrangements).
  • Pregnant women.
  • Children, covered under Title XIX.
  • Hospice patients.
  • American Indians or Alaskan Natives.
  • Non-institutionalized individuals whose care is subsidized by the Department of Children and Family Services or the Department of Corrections.
  • Individuals enrolled in "Health Benefits for Persons with Breast or Cervical Cancer."

Collection of Co-payments

The department will automatically deduct the co-payment from the provider's reimbursement. When billing the department, providers should bill their usual and customary charge and should not report the co-payment on the claim. Providers will be responsible for collecting co-payments from the participant.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs

Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director

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